B12 injections

[Shezaad]

Hi, my doctor has agreed to give me b12 injections. I have to write a letter detailing my private blood test (result was 193 (range 140-724) which according to my investigations is inadequate.

I have hashimotos (am recently 100% gluten free) so am aware of malabsorption issues.

I want to confirm that levels below 500 with neurological symptoms should be addressed imm & that levels should be top of the range for hashi's disease & I cannot find where I red this. Can anyone help?

Thanks.

[Gambit62 Administrator]

you need to quote the units of measure as well as the range - best thing would probably be to enclose a copy of the test results.

serum B12 isn't a gold standard test for B12 deficiency. There is a significant amount of variation in levels in a healthy set of patients which means that it will miss 25% of people who are B12 deficient but would also catch 5% who aren't.

BCSH (British Committee for Standards in Haematology) standards for diagnosis and treatment of cobalamin and folate deficiencies recommend that treatment should be based on clinical presentation where there is a discrepancy between test results and clinical presentation. They particularly stress that treatment should not be delayed if the clinical presentation includes neurological symptoms because there is a risk if left untreated that these symptoms will become irreversible.

Your GP can access these standards through the BNF but they can also be accessed here

onlinelibrary.wiley.com/doi...

In relation to your question about '500'

There have been reports of neurological damage occurring in patient whose B12 levels were as high as 500-550pmol/L. This is quite different from saying that everyone will suffer damage if their levels are below this.

Serum B12 is measuring levels in the blood - this is only part of the picture - B12 needs to get from your food into your blood and then from your blood into your cells and then it has to be used in your cells. Things can go wrong at any of these points. The effects will be the same. So, evaluating on the basis of results that are only looking at one step can be problematic. It is actually possible to have very high B12 levels and for this to cause a reaction that stops the B12 moving from blood to cells leading to a 'functional B12 deficiency'.

The efficiency of processes in cells can also be affected, generally by genetic factors but we are a long way from really understanding that and how different genetic variants that may be present will affect the overall picture. There will also be environment factors that aren't fully understood. Although MTHFR is frequently mentioned in relation to B12 it isn't really a significant factor. Even its impact on folate seems to be tied to some very specific gene variant combinations.

[Shezaad in reply to Gambit62]

The units are as follows:

193 pmo1/L. Range 140-724

[Gambit62 Administrator in reply to Shezaad]

was pretty sure it was pmol/L - make sure you include the units in the letter if you mention it rather than just referring to enclose cop of results.

[Shezaad in reply to Gambit62]

Yes it prob is an l and not a 1!! Doh!

Thanks.